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This from the BMJ was quite widely reported last week in the UK and seemingly is quite promising - a therapy that uses a natural source and not a synthetic compound.

In clinical practice, hypericum extract [St Johns' Wort JFH] is better tolerated than synthetic antidepressants. It may be particularly helpful in severe depression with its high risk of chronicity. We compared the efficacy and safety of hypericum extract with paroxetine in patients with moderate to severe depression.

Hypericum extract WS 5570 at a dose of 300 mg three times a day has been shown to be more effective than placebo in patients with mild to moderate major depression treated for six weeks. Paroxetine, on the other hand, is a potent selective serotonin reuptake inhibitor with proved efficacy in patients with depression of any severity and has a more favourable safety profile than tricyclic antidepressants. In major depression, daily doses between 20 mg and 50 mg have been recommended and are commonly used in clinical trials and in daily practice.

Several Studies have shown that St. John's Wort is at least as effective as TCAs and SSRIs in the treatment of depression. This research adds to our knowledge only in suggesting that St. John's Wort may be as effective in the treatment of severe depression. However, one detects a hidden agenda in this paper.

The paper is as much about suggesting that St. John's Wort is more user friendly than other antidepressants. This being so, we should question why the researchers chose to test St. John's Wort against Paroxetine (Seroxat). Of all the SSRIs, Seroxat has the worst reputation, with survivors groups around the world, accusations of a link with suicide, law suits, and enough adverse event reports to cause regulators around the world to alter their safety advice. Whether or not these allegations are true, the researchers behind this paper must have known that the Seroxat users in the trial would report a high number of adverse events, and that, consequently, St. John's Wort would appear considerably better tolerated by comparison.

The fact remains that St. John's Wort can have unpleasant side effects, and can be fatal if combined with some blood pressure drugs. What we do not have from this paper, or, as yet, from any other research is data for safety and efficacy from full-scale medical trials of the kind we would insist upon for any prescription medicine.

It is perhaps not surprising to find that the research was funded by by Dr William Schwabe Pharmaceuticals, a major supplier of so-called "herbal remedies" which can be legally sold as food addatives with no requirement to provide patient safety information or warnings about interactions with other medicines.

And yet again I'm thinking how naive am I That natural source is still processe. And of course by a "a major supplier". (And I found one bad Google reference for Dr William Schwabe Pharmaceuticals for which I couldnt find a resolution.)

Advertisement

Don Harrison and Elaine O'Connor
The Province; with a file from CanWest News Service

Wednesday, April 20, 2005

Canada yesterday become the first country to legalize a medicinal spray form of marijuana, to treat pain in the country's 25,000 multiple-sclerosis sufferers.

Health Canada said the pain of MS patients was not met by current prescription and over-the-counter medicines, so approval of the new marijuana drug was expedited.

The spray Sativex contains THC, the active ingredient in marijuana. It is to be taken every four hours in a spritz into the mouth, five times a day.

Sativex will be available by prescription in a 50-dose bottle at the end of June. Its retail price has yet to be established.

Mark Rogerson of the British manufacturer GW Pharmaceuticals admitted the new weed spray won't win any flavour contests.

It is "a bit like a breath freshener" and tastes like a "rather bitter Guinness" beer, he said.

He said patients won't get the pleasant buzz people receive from smoking a joint, adding the drug numbs pains in the nervous system without numbing a patient's brain.

"It's absolutely not necessary to become intoxicated in order to get pain relief," he said.

But Philippe Lucas, founder and director of Canadians for Safe Access, said overdosing could create a buzz.

Lucas, a legal medicinal-marijuana user, supported the availability of the spray for chronic-pain treatment.

But he said Sativex would be so closely controlled -- patients need to see a doctor before refilling a bottle, and bottles would be shipped on demand and not kept in stock -- that they may find it not worth the hassle.

"Availability is going to be very restricted. So for people suffering from MS and neuropathy, it may actually be prohibitive to have that much to go through."

When it comes to her health, Janice Winfield of Portland, Ore., does her research. That’s why the stay-at-home mom, who was diagnosed with multiple sclerosis in July 2000, was willing to turn to popular, over-the-counter herbal supplements like ginkgo biloba to deal with memory problems, fatigue and occasional muscle pain.

"I’m definitely interested in alternative medicine," said Winfield, 49, whose form of the neurological disease – relapsing-remitting MS – is characterized by frequent symptom flare-ups. Ginkgo "is not only given to someone like me with MS. There’s benefit to anyone taking it."

Findings by scientists in the Oregon Health & Science University School of Medicine’s Department of Neurology and the OHSU MS Center of Oregon appear to back up that claim. A study presented this month at the American Academy of Neurology’s 57th Annual Meeting in Miami Beach, Fla., suggests that ginkgo may be effective in improving attention in MS patients with cognitive impairment. Side effects also were minimal.

The study’s lead author, Jesus Lovera, M.D., a research fellow and instructor in neurology, OHSU School of Medicine, said those receiving ginkgo "performed better on a test that measures a person’s ability to pay attention and to sort conflicting information."

Of 39 patients completing the study, 20 received ginkgo biloba and 19 received placebo. Researchers found there were no differences in results between the two groups in the areas of gender, education, type of MS, years since onset, or baseline performance on a battery of neuropsychological tests.

But the ginkgo group was four seconds – about 13 percent – faster than the placebo group on a timed color and word test that measures attention and such "executive functions" as planning, decision making, and controlling goal-directed behavior and execution of deliberate actions.

During the test, called a "Stroop," patients are shown colored boxes and asked to name the colors. They are then shown the names of colors printed with different-colored inks, such as the word "green" printed in red, and asked to read the word. Finally, patients are asked to describe the ink used for each word.

Lovera said the differences in the Stroop result would be comparable to differences in scores between healthy people ages 30 to 39 and those ages 50 to 59.

Ginkgo appeared to be more beneficial for MS patients having specific problems in the Stroop, so "we would like to do another study in which we choose patients that are impaired in this particular test," Lovera said. "We would also like to test it at higher doses."

Ginko biloba is among several complementary and alternative medicine therapies being investigated by OHSU’s Department of Neurology for their effects on symptoms of neurological disease. Studies have ranged from clinical trials of lactoferrin for treating Alzheimer’s disease to the use of yoga as a therapy for MS fatigue.

Ginkgo is derived from the leaves of the ginkgo tree, one of the oldest species of trees, and has been used for thousands of years by the Chinese as an herbal remedy for a variety of ailments. It contains potent antioxidants called flavoglycosides that have been shown to have neuroprotective effects in animal models of spinal cord injury. It also has terpene-lactones that block a substance known as platelet activitating factor, which is important in regulating blood vessel function as well as the mediating inflammation and the sticking of inflammatory cells to blood vessels.

Many MS patients have long suspected that ginkgo improves disease symptoms. In a recent survey of 1,913 patients in Oregon, 20 percent reported using the supplement and 39 percent found it to be beneficial. However, until now, there was no evidence the supplement had any effect on memory.

"It has been shown to be of benefit in Alzheimer’s, but we did not know if it would work for MS," Lovera said. "We wanted to see if there was any suggestion that it could help patients with MS that are having cognitive problems."

Lovera said the study results demonstrate that ginkgo shouldn’t be discounted for treating MS, but its safety and efficacy must be tested in much larger clinical trials before doctors should recommend it to their patients.

"The study suggests that for cognitive problems, it may only help a certain group of patients," he said. "We need to study this further."

And for MS sufferers like Winfield, who participated in the ginkgo study, the herbal supplement will remain one of the many weapons in her arsenal for fighting the disease.

"I would do it again," she said of taking ginkgo. "It could have a benefit for me that I didn’t have before." But she emphasizes that "every MS is different, so what might work for me may not work for anybody else. But when it comes to alternative medicine, I’m all for that."

Has anyone ever heard of an herbal remedy called polypodium leucotomos, brand name Kalawalla. I stumbled upon an internet ad claiming that the substance is a natural immune regulator that helps control rogue T cells and that it has been used in Europe for 10 years or so in the treatment of MS and other immune system illnesses.

I saw the same ad, and went to the NLM website to see if anything had been published about it in the medical literature, with no luck finding any info. I'm also in the U.S., and don't know what information there may be out there on the European side.

I had run the search in PubMed on scientific name along with multiple sclerosis and nothing came up. When I re-ran without MS I got the hits you found - scanning them I didn't find any specific to MS. It does look like the botanical has some active properties as a treatment for dermatological problems and is being investigated for effects on expression of adhesion molecules.

To cut the search down on the web I ran the botanical name along with MS in Google and got 41 sites - some are just selling the extract, but others had a little more information. The extract of the polypodium has recently been issued a U.S. patent, link below:

The patent application was filed by either a Spanish or South American company - I can't tell which. There is mention of a 1 year clinical trial in MS patients that reported some normalization of immune profiles and clinical stabilization. The extract is also called Anapsos.

that lists a presentation of what might be the patent study at the European Neurological Society in June of 1999, abstract is by DeCastro et al.

The impression that I have right now is that there has been limited work done with this product specifically in relation to MS, and there is nothing in the published medical literature in PubMed. Maybe there is a publiication of the presentation with the European Neurological Society that is not indexed online. I've learned from the LDN use that publication in medical journals is not everything! However, the only groups claiming widespread use and success with MS by using this product are the sites selling the extract - other sites I came up are puzzled MS people (like us) wanting to know what it is - I haven't yet found a site where people with MS have indicated they used it and it helped them.

It is possible there is more information in the Spanish language websites, so someone who knows Spanish and can search in it may find more info.

There is some indication that the product does have immunomodulating properties and there is a 1-year clinical study that sounds encouraging - I would sure like to get more information about the study! Maybe someone with access to a good library can find it, or someone who speaks Spanish can talk to the authors.

LisaBee wrote:The impression that I have right now is that there has been limited work done with this product specifically in relation to MS, and there is nothing in the published medical literature in PubMed.

I think that there are at least a couple of papers that are probably relevant to MS. For example, Gonzalez et al. discuss that P. leucotomos extract induces a Th1 to Th2 shift in vitro with peripheral blood mononuclear cells. Of particular interest is the decrease in interferon-gamma as administration of interferon-gamma is known to worsen MS.

It is possible there is more information in the Spanish language websites, so someone who knows Spanish and can search in it may find more info.

To translate text or web pages, you can try Babelfish. Quite often, Babelfish will get the translation close enough so that the text will be readable without loosing too much context.

I was reading this book of Nutritional Medicine and it mentioned that Grape-seed extract & CoQ10 are recommended for MS patients. Has anyone tried these before? Would really like to hear some views on this.

Yes I have tried both. I am taking Q10 at present to help counteract the fatigue I get from taking Lipitor which apparently depleats a particular enzyeme in the body. Q10 allows your body to absorb energy from your food effectively and also a good antioxident which Grape Seed extract is also.

Thanks for the comment Jill, I'll will add these two to the supplements that I'm taking. I'm thinking of taking up the "Best Bet Diet" but it looks too tough for me to follow thru strictly. Maybe just restrict the consumption of some of the 'suspect" foods.

With respect to grape seed extract, at least one group of researchers has found that it may be contra-indicated for MS. This paper indicates that grape seed extract may NOT be a good idea for people with MS as it increases the production of gamma interferon promoting a Th1 immune response.

Abstract:
Although flavonoids manifest a diverse range of biological activities, including antitumor and antiviral effects, the molecular mechanisms underlying these activities await elucidation. We hypothesize that the flavonoid constituents of a proprietary grape seed extract (GSE) that contains procyandins exert significant antiviral and antitumor effects, by inducing production of the Th1-derived cytokine gamma interferon (IFN-gamma) by peripheral blood mononuclear cells) from healthy donors. Our results show that GSE significantly induced the transcription of IFN-gamma mRNA as demonstrated by reverse transcription-PCR but had no effect on the Th2-derived cytokine interleukin-6. The enhancing effect of GSE on IFN-gamma expression was further supported by a concomitant increase in the number of cells with intracytoplasmic IFN-gamma as well as the synthesis and secretion of IFN-gamma. Our results demonstrate that the potentially beneficial immunostimulatory effects of GSE may be mediated through the induction of IFN-gamma.

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